Purpose: In general clinical practice, the oral and maxillofacial surgeon is frequently required to treat patients on anticoagulant therapy. The purpose of this paper is to review the literature in order to provide evidence-based guidelines for the management of anticoagulated patients undergoing oral and maxillofacial surgery. Materials and Methods: Literature published over the past 40 years was reviewed. The management of patients on anticoagulant therapy as well as laser-assisted oral and maxillofacial surgery is discussed. Results: Currently, the continuation of anticoagulant therapy is strongly encouraged when INR is within the therapeutic range and meticulous local hemostatic measures are taken. Conclusion: It may be concluded that the risk of postoperative bleeding is outweighed by the higher risk of thromboembolism after withdrawal of the anticoagulant therapy and thus continuation of the anticoagulant regimen is encouraged. Laser-assisted oral and maxillofacial surgery in daily practice has enabled surgeons to achieve controlled hemostasis and minimize intra- and postoperative hemorrhage without discontinuing anticoagulants.

Purpose: The objective of the study was firstly to examine the surface morphology of enamel under scanning electron microscopy (SEM), following Er:YAG laser ablation and conventional high-speed bur preparation, with and without acid etching, and secondly to investigate the adhesion of composite resin (CR) to those surfaces by means of a shear bond strength (SBS) test. Materials and Methods: The buccal surface of 42 human extracted molars were ground flat using 500-grit silica carbide paper under water. The surfaces were subjected to simulated cavity preparation treatment and placed into groups: (1) Er:YAG laser ablation (350 mJ,10 Hz, VSP), (2) Er:YAG ablation plus acid etching (37% phosphoric acid), (3) conventional bur (Diamond Fis Z10), (4) conventional bur plus acid etching. Three teeth from each group (n = 3) were examined under SEM (Philips XL 30) to determine the nature of the treated surface. The remaining teeth in each group (n = 10), except group 3, underwent an SBS test to investigate the bond strength of CR to those surfaces, using a universal testing machine (Hounsfield; Hounsfield, UK) following ISO standard TR 11405. Results: Er:YAG laser irradiation resulted in roughened, irregular whitish enamel surfaces, resembling a typical Type I or Type II acid-etch pattern. Surfaces prepared by conventional high-speed bur exhibited a diffuse smear layer that was removed following acid etching. Shear bond strength testing revealed that there was no statistically significant difference in values between acid-etched/laser-ablated (15.89 MPa ± 1.90) and conventionally prepared and etched enamel surfaces (16.55 MPa ± 3.88) (p > 0.05). However, samples of Er:YAG irradiation without acid etching produced significantly lower (p < 0.05) SBS values (10.10 MPa ± 3.57). Discussion: Er:YAG laser irradiation produced surfaces visually similar to an acid-etch pattern, although without a smear layer. Both the conventional bur- and laser-prepared samples exhibited similar surfaces following acid etching. Enamel bond strength produced by Er:YAG laser ablation is comparable to that obtained by the conventional bur. However, within the limitations of this study, Er:YAG irradiation alone cannot be recommended as a viable alternative to acid etching to increase bond strength to enamel. Conclusion: It was concluded that the Er:YAG laser compared very favourably with the conventional bur in preparing enamel surfaces for restoration with composite resin. Of clinical significance, however, is that while the surface produced by the Er:YAG laser is similar to the conventionally prepared, etched enamel surface, it still requires acid etching to obtain an equivalent bond strength.

Purpose: The objectives of the present study were to determine the changes in the ultrastructure of human dentine resulting from simulated cavity preparation by an Er:YAG Laser, and to investigate the optimal parameters of that laser for ablating dentine. Materials and Methods: Whole extracted caries-free human molars were used in this experiment. A slice of coronal enamel was removed to expose dentine above the pulp chamber. Irradiation was carried out using an Er:YAG laser with different combinations of energy levels, frequencies and pulse modes. Samples were then prepared for SEM analysis. Results: Within the Er:YAG laser parameters tested, several characteristic features were evident on the dentine surface. The features included absence of smear layer, open dentinal tubules, microroughness, and crater-like appearance. It was also demonstrated that intertubular dentine is more prone to ablation compared to peritubular dentine. SEM analysis also indicated that the optimal parameters, which produced the cleanest and smoothest treated dentine surface, were around 250 mJ energy level, variable square pulse (VSP) mode, and 10 Hz frequency. Conclusion: This study reported on some of the visible effects of Er:YAG laser treatment of dentine. Features such as open dentinal tubules, absence of smear layer and crater like appearance were similar to those effects noted in previous reports. However, other characteristics such as microirregularities and microprojections have not been previously described. The clinical relevance of the paper is that its findings validate the optimal performance parameters recommended by the manufacturer (Fotona Laser Systems).

Purpose: The aim of this study was to analyze the interaction between the high-power diode laser and the dental root surface. Materials and Methods: Twenty-one single-rooted teeth were divided into 3 experimental groups. Group 1: Root surfaces were treated with scaling and root planing followed by high-power diode laser irradiation in the gated-pulsed mode (wavelength 808 nm, 400 µm optical fiber used parallel to the root surface, 1.5 W for 30 s, 10 Hz, pulse width of 50 µs). Group 2: Root surfaces were treated as in group 1, but irradiated in the continuous- wave mode. Group 3: Control - scaling and root planing using a Gracey curette. The temperature variation, root surface morphology, and proliferation of fibroblasts cultured on the root surfaces were analyzed. Results: There was an increase in temperature within the biological safety limits; it was significantly higher for group 2. Irradiation modified the smear layer, which exhibited rough areas intermingled with smooth areas. Open dentinal tubules were not observed. The fibroblasts proliferated throughout the experimental time (0 to 3 days). The growth curves of all groups were similar. Conclusion: Under the conditions of this study, we concluded that the use of high-power diode laser for root-surface conditioning is thermally safe and causes similar superficial morphological changes independent of the irradiation mode used. Additionally, these lased root surfaces are biocompatible, because cell adhesion and growth were not impaired.

Purpose: The purpose of the present study was to compare the short-term effect of scaling and root planing alone (SRP), diode laser (980 mn) treatment alone (LAS), and SRP combined with LAS (SRP+LAS) on clinical and microbial parameters in aggressive periodontitis (AgP). Materials and Methods: Thirty AgP patients (14 men, 16 women) aged 41.8 ± 6.2 years, 18 smokers, 12 nonsmokers, participated in this study. Clinical assessments of plaque (Pl), bleeding upon probing (BOP), probing pocket depth (PPD) and clinical attachment level (CAL) were made prior to treatment. Four plaque samples were randomly obtained from each individual, one in each quadrant. Following baseline (BL) clinical evaluation, each quadrant randomly received the following treatment modalities: SRP, SRP+LAS, LAS, CRL. A 980-nm diode laser (SmilePro980, Biolitec, Jena, Germany) was used for the laser treatment in a continuous focused mode and 2 W power setting. Subgingival plaque samples were collected from the same sites in each quadrant 2, 6, and 12 weeks after treatment. Clinical parameters were also recorded at the same time intervals. The level of Porphyromonas gingivalis, Tannerella forsythia (Bacteroides forsythus), Actinobacillus actinomycetemcomitans, Treponema denticola, and total bacterial load was evaluated using ssrRNA probes (IAI Pado Test 4.5, Institut für Angewandte Immunologie). Results: Repeated measures analysis showed a significant time effect on bacterial counts, which were decreased following the three treatment modalities in all quadrants. They did not reach baseline levels 12 weeks after treatment. SRP+LAS showed lower bacterial levels than SRP or LAS at every time point after treatment. For T. forsythia, there was a significant time-by-treatment interaction effect, showing that each treatment had a different performance over time (F = 6.51, p = 0.001). Similar effects were observed for total bacterial load (F = 6.90, p = 0.003). Regarding P. gingivalis and T. denticola, time effects were significant (F = 6.84, p = 0.009, and F = 12.45, p<0.001, resp). Treatment effects were significant for P. gingivalis (F = 7.96, p = 0.003). It is noteworthy that the SRP+LAS mean levels for all bacteria at the final follow-up point were never higher than the corresponding levels of the other treatments immediately after treatment (0.346 vs 0.369 for T. forsythia, 0.266 vs. 0.548 for P. gingivalis, 0.155 vs 0.211 for T. denticola, and 3.580 vs 6.798 for total bacterial load. At the control sites, the bacterial counts showed no significant decrease. Conclusion: Diode (980 nm) laser-assisted treatment with SRP showed a superior effect over SRP or LAS alone in both clinical and microbial parameters of AgP over a monitoring period of 12 weeks

Purpose: The aim of the present series of case reports was to evaluate the combination therapy of intrabony periodontal defects using an Er:YAG laser (ERL) and enamel matrix protein derivative (EMD). Materials and Methods: Fifteen patients with chronic periodontitis, each of whom displayed one intrabony defect, were randomly treated with access flap surgery and root surface/defect debridement using ERL (16.5 J/cm2) followed by the application of EMD. The following clinical parameters were recorded at baseline and at 6 months: plaque index (PI), bleeding on probing (BOP), probing pocket depth (PD), gingival recession (GR), and clinical attachment level (CAL). Results: Healing was uneventful in all patients. At 6 months after therapy, the sites treated with ERL and EMD showed a mean PD reduction from 8.5 ± 1.1 mm to 4.7 ± 0.8 mm and a mean CAL change from 10.5 ± 1.4 mm to 7.6 ± 1.4 mm (p < 0.001). Conclusion: Within the limits of this case series, it may be concluded that the combination of ERL and EMD may improve clinical healing of intrabony periodontal defects over a period of 6 months.

Soft tissue health and esthetics are important factors in achievement of an attractive smile. The relationship between periodontium and restoration is critical if gingival health and esthetics are the goal. Current use of lasers in esthetic dentistry includes a wide variety of soft tissue procedures. Numerous wavelengths are used, and their specific use depends on different tissue absorption characteristics. When laser surgery is considered, it is important to follow the same principles as in conventional periodontal surgery. The zone of attached gingiva, alveolar crest position, gingival sulcus, epithelial attachment, and periodontal ligament must be taken in consideration. This article discusses use of a CO2 laser in soft-tissue management of diastema closure and gingival hyperpigmentation. We will demonstrate how CO2 laser can be used to manage the soft tissues in association with the restoration to improve esthetics.